Workers’ Compensation Fraud

What is Workers’ Compensation Fraud?

Workers’ compensation is an insurance system that provides medical care and payments for those who are injured on the job. Worker’s compensation fraud is committed when:

You make or cause to be made a knowingly false and fraudulent material statement or representation for the purpose of either obtaining or denying worker’s compensation benefits.

You make a false or fraudulent statement in support of or opposition to a claim for workers’ compensation benefits.

You knowingly aid and abet or participate in a conspiracy to commit worker’s compensation fraud.

You make or cause to be made a knowingly false or fraudulent statement with regard to entitlement to benefits, with the intent to discourage an injured worker from claiming benefits or pursuing a claim.

All those legal terms can be hard to understand, so here are some definitions to make it more clear.

Workers’ Compensation Benefits

If a worker is injured on the job, workers’ compensation benefits cover medical care, temporary disability wages, permanent disability wages, and death benefits. Workers’ compensation is a “no-fault” system, meaning that it doesn’t matter if your injury is your own fault, it’s still covered by the workers’ compensation insurance policy.

Statement or Representation

A statement or representation can be any of the following:

An oral or written statement or representation by the person making the claim

A proof of injury

A notice

A bill for services

Payment for services

X-ray or test results

Hospital or doctor records

Proof of medical-legal expenses

Any other evidence of loss, injury, or payment made.

Penalties for Workers’ Compensation Fraud

Workers’ compensation fraud is known as a wobbler, meaning it can be charged as a misdemeanor or a felony depending on the circumstances and your criminal history. When charged as a misdemeanor the penalties include:

Misdemeanor probation,

Up to one year in county jail,

A fine up to $150,000 or double the amount of the fraud, whichever is greater, and/or

Restitution to any parties who were victims of the fraud.

When charged as a felony the penalties include:

Felony probation,

Two, three, or five years in a county jail under California’s realignment program,

A fine up to $150,000 or double the amount of the fraud, whichever is greater, and/or

Restitution to any parties who were victims of the fraud.

Legal Defenses for Workers’ Compensation Fraud

Workers’ compensation fraud is a serious crime and has severe penalties. That’s why it’s important to hire an experienced criminal defense lawyer to fight for you. Here are some of the most common legal defenses for workers’ compensation fraud.

You did not act with knowledge or fraudulent intent

In order to be guilty of this crime, you must have acted with knowledge that a particular statement was false or with fraudulent intent. The prosecutor must prove beyond a reasonable doubt that this is true in order for you to be guilty.